Boswellia carterii / Boswellia serrata

Boswellia, frankincense, olibanum

Description

Frankincense, also known as olibanum, is one of the oldest aromatic materials used by mankind. Already in the antiquity it was used as incense in Mesopotamia, Egypt, Greek and Rome. Ovid speaks of the solidified olibanum droplets as 'tears'. The Catholic Church adopted the use of incense burning in the 5th century. The smell of olibanum smoke is influenced by a multitude of pyrolysis products from the terpenoids present in the resin. Commercial olibanum oil obtained by steam distillation of the resin from mixed Boswellia species has a sweet, woody-balsamic odour with a fresh, almost citrusy nuance.1

Olibanum is obtained from resin of trees of the genus Boswellia (Burseraceae family). The resin is produced predominantly by four species, including Boswellia serrata in india, Boswellia carterii in East Africa and China, Boswellia frereana in Somalia and Boswellia sacra in Northern Africa and Arabia. The term guggals collectively refers to gum resins. Boswellia serrata is used in Ayurvedic medicine as an antiarthritic, astringent, stimulant, expectorant, and antiseptic agent2 while Boswellia carterii (ruxiang) is mainly used in Traditional Chinese Medicine to alleviate pain and inflammation and for cancer.3

Animal and in vitro studies suggest possible benefit for inflammatory conditions such as inflammatory bowel disease, rheumatoid arthritis, chronic colitis, ulcerative colitis, Crohn's disease, ileitis, acne, skin allergies and ulcers, peritumoral brain edema, and osteoarthritis. Small human studies suggest boswellia is effective for chronic therapy for asthma and arthritis.

Constituents

The Boswellia gum oleoresin contains oils, terpenoids, sugars, and volatile oils. Boswellia carterii contains much more aliphatic octyl acetate, which is responsible for the strong smell when burning the resin, compared to B.serrata. B. carterii also contains verticilla-4-7,11-triene, incesole acetate, incensole while B. serrata contains m- and p-camphorene and cernbrenol (serratol).4

Importantly, both B. carterii and B. serrata contains the active pentacyclic triterpene acids α- and β- boswellic acid, 11-keto-β-boswellic acid, acetyl-11-keto-β-boswellic acid, acetyl-11-dien- β-boswellic acid, acetyl-α- boswellic acid and acetyl-β-boswellic acid. 2, 5 Acetyl-11-keto-β-boswellic acid (AKBA) is considered to be the major constituent in boswellia.

Pharmacology

Antilipemic activity

Boswellic acids have been found to reduce serum cholesterol and triglycerides in vivo.6

Anti-inflammatory activity

The boswellia acids (pentacyclic triterpenic acids) have been identified as major anti-inflammatory components of boswellia gum resin extract. Doses of 50-200mg/kg of boswellia extract given orally to mice following the injection of an inflammatory agent into the intra-pleural cavity, have been shown to inhibit polymorphonuclear leukocyte (PMN) infiltration similar to the effect seen with indomethacin. Similarly effective anti-inflammatory activity has been observed in studies of rats with laboratory-induced paw inflammation, and in animal models with arthritis, gouty arthritis, and polyarthritis. Antipyretic activity in rats and rabbits has also been noted.7

Acetyl-11-keto-β-boswellic acid has been identified as one of the primary anti-inflammatory trepertinoid acids in boswellia resin extract. Animals studies show that it inhibits the release of leukotrienes B4 (LTB4), which are potent inducers of bronchoconstriction and asthma. Additional studies have found that boswellia inhibits human leukocyte elastase (HLE), which is involved in the pathogenesis of emphysema, cystic fibrosis, chronic bronchitis, and acute respiratory distress syndrome. Boswellia extract may also inhibit TNF-alpha induced inflammatory.7

Anticancer activity

Apoptotic, cytostatic, and antiproliferative activity against a number of cancer cell lines via different mechanisms have been demonstrated in in vivo and in vitro studies. Acetyl-11-keto-beta-boswellic acid (AKBA) was shown to potentiate apoptosis induced by TNF and chemotherapeutic agents, suppress TNF-induced invasion, and inhibit receptor activator of NF-kappaB ligand-induced osteoclastogenesis.8

Immunostimulant activity

Distilled 3% boswellia (frankincense) oil has been shown to have strong immunostimulant activity (90% lymphocyte transformation) in vitro. Another study suggests that the immunstimulant effect is mediated via stimulation of signalling pathways that control functional leukocyte responses in a manner similar to that of platelet-activating factor involving formation of ROS, arachidonic acid and leucotriene release.10

Clinical studies

Asthma

A six-week randomised, double-blind, placebo controlled, controlled study of 80 patients with bronchial asthma found that boswellia gum resin improvemed FEV1 (forced expiratory volume in one second), FVC (forced vital capacity), number of asthma exacerbations, and wheezing following 41 days of boswellia therapy. Secondary effects such as reduced dyspnea and eosinophilia, and absence of rhonchi (coarse rattling) after treatment, were also apparent in the boswellia group compared to placebo. In addition, the number of asthma exacerbations was significantly reduced in the boswellia group (p<0.0001).11

Brain tumors

Boswellia is traditionally used for cancer and there are numerous lab and animal studies showing that boswellia decreases inflammation and has antineoplastic effects. Boswellia is specifically to reduce intracranial tumors or oedema caused by these tumours.

A case study of 12 patients with brain tumours and progressive oedema found that boswellia reduced oedema in two of seven patients with glioblastoma and in three of five patients with treatment-related leukoencephalopathy. For several months, all patients with leukoencephalopathy showed clinical improvement.12 Another case study of 19 children and adolescents with intracranial tumours found that boswellia improved general health in five of 19 patients. All patients had previously been treated with conventional therapy, including radiation and chemotherapy. There was transient neurological improvement, including in paresis and ataxia, in three of 17 patients with malignant tumours. Another three patients had improved muscle strength, and one cachectic (wasting) patient showed increased weight gain.13

Osteoarthritis

Earlier studies showed that boswellic acids reduces enzymes that are elevated in inflammatory conditions like arthritis, such as glutamic pyruvic transaminase, glycohydrolase, and beta-glucuronidase inhibition of glycosaminoglycan (GAG) synthesis and urinary excretion of connective tissue metabolites by boswellic acids have been proposed as support for the purported beneficial effects of boswellia in preventing the degradation of connective tissue in inflammatory arthritic conditions.7 A randomised, double-blind, placebo controlled, crossover study in 42 patients with osteoarthritis found that a boswellia combination product (boswellia, withania, turmeric and zinc) significantly improved the mean pain severity score (p<0.001) and mean disability score (p<0.05) (Ritchie articular index, American Rheumatism Association joint score). Other parameters, including morning stiffness, grip strength, and joint score, also showed improvement, but without statistical significance.14

Another randomised, double-blind, placebo controlled, crossover pilot study of 30 patients with osteoarthritis of the knee found that boswellia produced a significant improvement in terms of pain, flexion, and walking distance compared to placebo.15

Rheumatoid arthritis

Boswellia carterii is used in traditional Chinese medicine (TCM) to reduce swelling and alleviate the pain of inflammatory diseases. The inflammatory process of rheumatoid is reportedly associated with an increase of the pro-inflammatory cytokines TNF-α and IL-1β which may explain the use of boswellia in TCM for inflammation.

In a double-blind, placebo controlled, pilot study, a review of a 37-patient single-centre subset of 78 rheumatoid arthritis patients found that boswellia usage was associated with a small, non-statistically significant reduction in the usage of NSAIDs compared to placebo (5.8% vs 3.1% respectively). Boswellia was not found to be effective in reducing pain or improving function as measured by validated scales, and no differences in C-reactive protein were observed between groups. A review of 11 unpublished studies conducted between 1985-1990, ranging from 1-6 months in duration and involving 260 patients concluded that boswellia was not efficacious for the relief of acute pain, but improved chronic symptoms, such as joint swelling and stiffness, and may reduce NSAID intake. No statistical analysis was reported in this review.17

Boswellia is frequently combined with other anti-inflammatory herbal extracts. The combination of Boswellia serrata, Withania somnifera (Ashwagandha), Zingiber officinale (ginger), and Curcuma longa (turmeric) is commonly used in India. A significant improvement in rheumatoid arthritis was observed in 2 studies using this combination. A 16-week randomised, double-blind, placebo controlled trial of 182 patients found that boswellia produced a reduction in the number of swollen joints and swollen joint score; reduced rheumatoid factor (30% reduction versus 0%); and produced a relative improvement in the "ACR 20" (American College of Rheumatism) assessment score (39% vs. 30%).18

In the second randomised, double-blind, placebo controlled, crossover study, the same combination produced moderate improvement in pain, morning stiffness duration, grip strength, and disability score vs. placebo (p< 0.001). After three months, rheumatoid factor seroconversion (to seronegativity) occurred in nine patients taking boswellia and in none taking placebo. Non-steroidal anti-inflammatory drugs were required to control symptoms in three patients taking boswellia vs. 18 taking placebo (p<0.05).19

Crohn's disease and Ulcerative colitis

An eight-week randomised, double-blind equivalence study found that a boswellia extract improved symptoms compared to a standard drug (mesalazine, trade names Mesalsal and Salofalk) however the improvement was not statistically significant.20

Two open, non-randomised equivalence pilot studies involving 72 patients with chronic colitis found that boswellia greatly improved symptoms of ulcerative colitis after 6 weeks treatment.21, 22 Boswellia is also reported to improve symptoms in 31 patients with collagenous colitis. 44% of patients who received active treatment showed clinical improvement, compared to 27% of patients who received placebo (p=0.32).23

Actions

Anti-inflammatory, anti-carcinogenic, anti-proliferative, anti-tumor, cytostatic, and apoptotic activity.

Traditional usage

Boswellia has traditionally been used for a number of topical applications, including the treatment of acne, bacterial infections, fungal infections, boils, wound healing, scars, and varicose veins. It is used cosmetically as a facial toner and to smooth wrinkles. In Ayurvedic medicine, boswellia is used to destroy toxins, as a rejuvenative, to cleanse the 'orifices of the head', to redirect the flow of vata downwards, to clear adhesions from the body and for its analgesic, aphrodisiac and bone healing properties. Boswellia is also used in the treatment of fibroids, cysts, painful periods with clots and pain caused by congestion.24

Chinese herbalists use boswellia in powder form and in teas to treat rheumatism, menstrual pain, and as an external wash for sores and bruises.

Energetics

Frankincense has dual energetics of being both heating and cooling. It is heating due to its stimulation of blood circulation and cooling due to its anti-inflammatory effects. It is bitter, pungent, astringent and sweet.24

Indications

  • Arthritis
  • Rheumatoid arthritis
  • Asthma
  • Ulcerative colitis
  • Crohn's disease
  • Cancer

Use in pregnancy

Reports in the Indian literature suggest that resin from boswellia is an emmenagogue and may induce abortion.25 Safety of boswellia during pregnancy has not been systematically studied, and therefore cannot be recommended. Avoid use during pregnancy due to potential abortifacient effects. Studies on the effects of boswellia on breast milk and lactation are lacking.

Contraindications and cautions

No serious adverse events were seen after oral administration of boswellia in any of the studies. The most common adverse effects in trials have been nausea and acid reflux.

Allergic contact dermatitis has been associated with the use of a cream containing boswellia extract in one case report.26 Avoid in individuals with a known allergy to boswellia, its constituents, or members in the family Burseraveae.

Administration and Dosage

Boswellia (resin) 1:1 80%alc - Boswellia carterii 0.3 to 0.6mL 3 times daily.

References

  1. Jensen B. A small guide to Nature’s fragrances http://www.bojensen.net/EssentialOilsEng/EssentialOils21/EssentialOils21.htm accessed 22/09/2008
  2. Thorne Review. Boswellia serrata. Monograph. Altern Med Rev 2008; 13(2):165-167.
  3. Fan AY, Lao L, Zhang RX, Zhou AN, Wang LB, Moudgil KD et al. Effects of an acetone extract of Boswellia carterii Birdw. (Burseraceae) gum resin on adjuvant-induced arthritis in lewis rats. J Ethnopharmacol 2005; 101(1-3):104-109.
  4. Kowalska T, Sherma J. (eds) Preparative Layer Chromatography Chromatographic Science Series 95:393
  5. Chevrier MR, Ryan AE, Lee DY, Zhongze M, Wu-Yan Z, Via CS. Boswellia carterii extract inhibits TH1 cytokines and promotes TH2 cytokines in vitro. Clin Diagn Lab Immunol 2005; 12(5):575-580.
  6. Atal CK, Gupta OP, and Singh GB. Salai guggal: a promising anti-arthritic and anti-hyperlipidemic agent. Proc BPS 1981;203P-204P.
  7. Boswellia (Boswellia serrata Roxb.) Natural Standard Monograph. http://www.naturalstandard.com. Accessed: 02/10/08
  8. Takada, Y., Ichikawa, H., Badmaev, V., and Aggarwal, B. B. Acetyl-11-keto-beta-boswellic acid potentiates apoptosis, inhibits invasion, and abolishes osteoclastogenesis by suppressing NF-kappa B and NF-kappa B-regulated gene expression. J Immunol 3-1-2006;176(5):3127-3140.
  9. Mikhaeil, B. R., Maatooq, G. T., Badria, F. A., and Amer, M. M. Chemistry and immunomodulatory activity of frankincense oil. Z.Naturforsch.[C.] 2003;58(3-4):230-238.
  10. Altmann, A., Poeckel, D., Fischer, L., Schubert-Zsilavecz, M., Steinhilber, D., and Werz, O. Coupling of boswellic acid-induced Ca2+ mobilisation and MAPK activation to lipid metabolism and peroxide formation in human leucocytes. Br J Pharmacol 2004;141(2):223-232.
  11. Gupta, I., Gupta, V., Parihar, A., Gupta, S., Ludtke, R., Safayhi, H., and Ammon, H. P. Effects of Boswellia serrata gum resin in patients with bronchial asthma: results of a double-blind, placebo-controlled, 6-week clinical study. Eur.J Med Res 11-17-1998;3(11):511-514.
  12. Sharma, S., Thawani, V., Hingorani, L., Shrivastava, M., Bhate, V. R., and Khiyani, R. Pharmacokinetic study of 11-Keto beta-Boswellic acid. Phytomedicine. 2004;11(2-3):255-260.
  13. Janssen, G., Bode, U., Breu, H., Dohrn, B., Engelbrecht, V., and Gobel, U. Boswellic acids in the palliative therapy of children with progressive or relapsed brain tumors. Klin Padiatr. 2000;212(4):189-195.
  14. Kulkarni RR, Patki PS, Jog VP, and et al. Treatment of osteoarthritis with a herbomineral formulation: a double-blind, placebo-controlled, cross-over study. J Ethnopharm 1991;33(1-2):91-95.
  15. Kimmatkar, N., Thawani, V., Hingorani, L., and Khiyani, R. Efficacy and tolerability of Boswellia serrata extract in treatment of osteoarthritis of knee--a randomized double blind placebo controlled trial. Phytomedicine. 2003;10(1):3-7.
  16. Sander, O., Herborn, G., and Rau, R. [Is H15 (resin extract of Boswellia serrata, "incense") a useful supplement to established drug therapy of chronic polyarthritis? Results of a double-blind pilot study]. Z.Rheumatol 1998;57(1):11-16.
  17. Etzel R. Special extract of Boswellia serrata (H15) in the treatment of rheumatoid arthritis. Phytomed 1996;3(1):91-94.
  18. Chopra, A., Lavin, P., Patwardhan, B., and Chitre, D. Randomized double blind trial of an ayurvedic plant derived formulation for treatment of rheumatoid arthritis. J Rheumatol. 2000;27(6):1365-1372.
  19. Kulkarni RR, Patki PS, Jog VP, and et al. Treatment of osteoarthritis with a herbomineral formulation: a double-blind, placebo-controlled, cross-over study. J Ethnopharm 1991;33(1-2):91-95.
  20. Gerhardt, H., Seifert, F., Buvari, P., Vogelsang, H., and Repges, R. [Therapy of active Crohn disease with Boswellia serrata extract H 15]. Z.Gastroenterol. 2001;39(1):11-17.
  21. Gupta, I., Parihar, A., Malhotra, P., Gupta, S., Ludtke, R., Safayhi, H., and Ammon, H. P. Effects of gum resin of Boswellia serrata in patients with chronic colitis. Planta Med 2001;67(5):391-395.
  22. Gupta, I., Parihar, A., Malhotra, P., Singh, G. B., Ludtke, R., Safayhi, H., and Ammon, H. P. Effects of Boswellia serrata gum resin in patients with ulcerative colitis. Eur J Med Res. 1997;2(1):37-43.
  23. Chande, N., McDonald, J. W., and MacDonald, J. K. Interventions for treating collagenous colitis. Cochrane.Database.Syst.Rev 2006;(4):CD003575.
  24. Pole S, Ayurvedic Medicine – The principles and traditional practice 2006; Churchill Livingstone:179-180
  25. Kamboj, V. P. A review of Indian medicinal plants with interceptive activity. Indian J Med Res 1988;87:336-355.
  26. Acebo, E., Raton, J. A., Sautua, S., Eizaguirre, X., Trebol, I., and Perez, J. L. Allergic contact dermatitis from Boswellia serrata extract in a naturopathic cream. Contact Dermatitis 2004;51(2):91-92.